“Disinfection is only recommended in indoor settings — schools and homes — where there has been a suspected or confirmed case of Covid-19 within the last 24 hours,” Dr. Walensky said during the White House briefing. “Also, in most cases, fogging, fumigation and wide-area or electrostatic spraying is not recommended as a primary method of disinfection and has several safety risks to consider.”

And the new cleaning guidelines do not apply to health care facilities, which may require more intensive cleaning and disinfection.

Saskia Popescu, an infectious disease epidemiologist at George Mason University, said that she was happy to see the new guidance, which “reflects our evolving data on transmission throughout the pandemic.”

But she noted that it remained important to continue doing some regular cleaning — and maintaining good hand-washing practices — to reduce the risk of contracting not just the coronavirus but any other pathogens that might be lingering on a particular surface.

Dr. Allen said that the school and business officials he has spoken with this week expressed relief over the updated guidelines, which will allow them to pull back on some of their intensive cleaning regimens. “This frees up a lot of organizations to spend that money better,” he said.

Schools, businesses and other institutions that want to keep people safe should shift their attention from surfaces to air quality, he said, and invest in improved ventilation and filtration.

“This should be the end of deep cleaning,” Dr. Allen said, noting that the misplaced focus on surfaces has had real costs. “It has led to closed playgrounds, it has led to taking nets off basketball courts, it has led to quarantining books in the library. It has led to entire missed school days for deep cleaning. It has led to not being able to share a pencil. So that’s all that hygiene theater, and it’s a direct result of not properly classifying surface transmission as low risk.”

Roni Caryn Rabin contributed reporting

View Source

Restaurant Workers Are in a Race to Get Vaccines

Over the course of the pandemic, some of the most dangerous activities were those many Americans dearly missed: scarfing up nachos, canoodling with a date or yelling sports scores at a group of friends at a crowded, sticky bar inside a restaurant.

Now, as more states loosen restrictions on indoor dining and expand access to vaccines, restaurant employees — who have morphed from cheerful facilitators of everyone’s fun to embattled frontline workers — are scrambling to protect themselves against the new slosh of business.

“It’s been really stressful,” said Julia Piscioniere, a server at Butcher & Bee in Charleston. “People are OK with masks, but it is not like it was before. I think people take restaurants and their workers for granted. It’s taken a toll.”

The return to economic vitality in the United States is led by places to eat and drink, which also suffered among the highest losses in the last year. Balancing the financial benefits of a return to regular hours with worker safety, particularly in states where theoretical vaccine access outstrips actual supply, is the industry’s latest hurdle.

priority groups this spring. Immigrants, who make up a large segment of the restaurant work force, are often fearful of signing up, worrying that the process will legally entangle them.

Some states have dropped mask mandates and capacity limits inside establishments — which the Centers for Disease Control and Prevention still deem a potentially risky setting — further endangering employees.

“It is critical for food and beverage workers to have access to the vaccine, especially as patrons who come have no guarantee that they will be vaccinated and obviously will not be masked when eating or drinking,” said Dr. Alex Jahangir, the chairman of a coronavirus task force in Nashville. “This has been a major concern for me as we balance the competing interests of vaccinating everyone as soon as possible before more and more restrictions are lifted.”

Servers in Texas are dealing with all of the above. The state strictly limited early eligibility for shots, but last week opened access to all residents 16 and over, creating an overwhelming demand for slots. The governor recently dropped the state’s loosely enforced mask mandate, and allowed restaurants to go forth and serve all comers, with zero limitations.

require their workers be vaccinated in the future.

Many business sectors were battered by the coronavirus pandemic, but there is broad agreement that hospitality was hardest hit and that low wage workers sustained some of the biggest blows. In February 2020, for instance, restaurant worker hours were up 2 percent over a previously strong period the year before; two months later those hours were cut by more than half.

While hours and wages have recovered somewhat, the industry remains hobbled by rules that most other businesses — including airlines and retail stores — have not had to face. The reasons point to a sadly unfortunate reality that never changed: indoor dining, by nature of its actual existence, helped spread the virus.

report by the C.D.C. found that after mask and other restrictions were lifted, on-premise restaurants led to daily increase in cases and death rates between 40 and 100 days later. Although other settings have turned into super-spreading events — funerals, wedding and large indoor events — many community outbreaks have found their roots in restaurants and bars.

“Masks would normally help to protect people in indoor settings but because people remove masks when dining,” said Christine K. Johnson, professor of epidemiology and ecosystem health at the University of California, Davis, “there are no barriers to prevent transmission.”

Not all governments have viewed restaurant workers as “essential,” even as restaurants have been a very active part of the American food chains — from half-open sites to takeout operations to cooking for those in need — during the entire pandemic. The National Restaurant Association helped push the C.D.C. to recommend that food service workers be included in priority groups of workers to get vaccines although not all states followed the guidelines.

Almost every state in the nation has accelerated its vaccination program, targeting nearly all adult populations.

“Most people in our government have considered restaurants nonessential luxuries,” said Rick Bayless, the well-known Chicago restaurateur, whose staff scoured all vaccines sites for weeks to get workers shots. “I think that’s shortsighted. The human race is at its core social and when we deny that aspect of our nature, we do harm to ourselves. Restaurants provide that very essential service. It can be done safely, but to minimize the risk for our staff, we should be prioritized for vaccination.”

Texas did not designate as early vaccine recipients any workers beyond those in the health care and education sectors, but is now open to all.

the Breadfruit and Rum Bar, declined unemployment insurance, and have shied from signing up for a shot. “Before you can even make an appointment you have to put in your name and date of birth and email,” Ms. Leoni said. “Those are questions that are deterrents for people trying to keep a low profile.”

In Charleston, Mr. Shemtov was inspired by accounts of the immunization program in Israel, which was considered successful in part because the government took vaccines to job sites. “If people can’t get appointments, let’s bring them to them.”

Other restaurants are devoting hours to making sure workers know how to sign up, locating leftover shots and networking with their peers. Some offer time off for a shot and the recovery period for side effects.

Katie Button, the owner of Curate and La Bodega in Asheville, N.C.

Still, some owners are not taking chances. “If we go out of business because we are one of the few restaurants in Arizona that won’t reopen, so be it,” Ms. Leoni said. “Nothing is more important than someone else’s health or safety.”

View Source

Fully Vaccinated Americans Can Travel With Low Risk, C.D.C. Says

Americans who are fully vaccinated against Covid-19 can safely travel at home and abroad, as long as they take basic precautions like wearing masks, federal health officials announced on Friday, a long-awaited change from the dire government warnings that have kept many millions home for the past year.

In announcing the change at a White House news conference, officials from the Centers for Disease Control and Prevention stressed that they preferred that people avoid travel. But they said growing evidence of the real-world effectiveness of the vaccines — which have been given to more than 100 million Americans — suggested that inoculated people could do so “at low risk to themselves.”

The shift in the C.D.C.’s official stance comes at a moment of both hope and peril in the pandemic. The pace of vaccinations has been rapidly accelerating across the country, and the number of deaths has been declining.

Yet cases are increasing significantly in many states as new variants of the coronavirus spread through the country. Just last Monday, Dr. Rochelle P. Walensky, the C.D.C. director, warned of a potential fourth wave if states and cities continued to loosen public health restrictions, telling reporters that she had feelings of “impending doom.”

suggested such cases might be rare, but until that question is resolved, many public health officials feel it is unwise to tell vaccinated Americans simply to do as they please. They say it is important for all vaccinated people to continue to wear masks, practice social distancing and take other precautions.

Under the new C.D.C. guidance, fully vaccinated Americans who are traveling domestically do not need to be tested for the coronavirus or follow quarantine procedures at the destination or after returning home. When they travel abroad, they only need to get a coronavirus test or quarantine if the country they are going to requires it.

coronavirus test before boarding a flight back to the United States, and they should get tested again three to five days after their return.

The recommendation is predicated on the idea that vaccinated people may still become infected with the virus. The C.D.C. also cited a lack of vaccine coverage in other countries, and concern about the potential introduction and spread of new variants of the virus that are more prevalent overseas.

Most states have accelerated their timelines for opening vaccinations to all adults, as the pace of vaccinations across the country has been increasing. As of Friday, an average of nearly three million shots a day were being administered, according to data reported by the C.D.C.

The new advice adds to C.D.C. recommendations issued in early March saying that fully vaccinated people may gather in small groups in private settings without masks or social distancing, and may visit with unvaccinated individuals from a single household as long as they are at low risk for developing severe disease if infected with the virus.

Travel has already been increasing nationwide, as the weather warms and Americans grow fatigued with pandemic restrictions. Last Sunday was the busiest day at domestic airports since the pandemic began. According to the Transportation Security Administration, nearly 1.6 million people passed through the security checkpoints at American airports.

But the industry’s concerns are far from over. The pandemic has also shown businesses large and small that their employees can often be just as productive working remotely as in face-to-face meetings. As a result, the airline and hotel industries expect it will be years before lucrative corporate travel recovers to prepandemic levels, leaving a gaping hole in revenues.

And while leisure travel within the United States may be recovering steadily, airlines expect it will still take until 2023 or 2024 for passenger volumes to reach 2019 levels, according to Airlines for America, an industry group. The industry lost more than $35 billion last year and continues to lose tens of millions of dollars each day, the group said.

the country’s government said

The C.D.C. on Thursday also issued more detailed technical instructions for cruise lines, requiring them to take steps to develop vaccination strategies and make plans for routine testing of crew members and daily reporting of Covid-19 cases before they can run simulated trial runs of voyages with volunteers, before taking on real passengers. The C.D.C.’s directives acknowledge that taking cruises “will always pose some risk of Covid-19 transmission.”

Some destinations and cruise lines have already started requiring that travelers be fully vaccinated. The cruise line Royal Caribbean is requiring passengers and crew members 18 or older to be vaccinated in order to board its ships, as are Virgin Voyages, Crystal Cruises and others.

For the moment, airlines are not requiring vaccinations for travel. But the idea has been much talked about in the industry.

Niraj Chokshi contributed reporting.

View Source

Family Travel Gets Complicated Without a Covid Vaccine for Kids

“Unvaccinated children would still need to quarantine for five days, and the parents, of course, must stay with the child,” said Eric Newman, who owns the travel blog Iceland With Kids. “Iceland’s brand-new travel regulations are not friendly to families hoping to visit with children.”

After a year of virtual schooling and working from home, parents have no desire to quarantine with their kids, said Anthony Berklich, the founder of the travel platform Inspired Citizen. “What these destinations are basically saying is you can come but your children can’t,” he said.

Instead, families are opting for warm-weather destinations closer to home.

When the Centers for Disease Control and Prevention announced in January that proof of a negative PCR test would be required of all air passengers arriving in the United States, many tropical resorts — including more than a dozen Hyatt properties — began offering not just free on-site testing, but a deeply discounted room in which to quarantine in case that test comes back positive. That move, said Rebecca Alesia, a travel consultant with SmartFlyer, has been a boon for family travel business.

“What happens if the morning you’re supposed to come home, you get up and Junior has a surprise positive test?” she said. “A lot of my clients have booked this summer because of this policy.”

For parents struggling to decide how and when to return to travel, there is good news on the horizon, said Dr. Shruti Gohil, the medical director of infection prevention at the University of California, Irvine.

“The chances of a good pediatric vaccine coming soon are high,” she said, noting that both Pfizer and Moderna are already running pediatric trials on their vaccines. “There is no reason to think that the vaccine will have any untoward effects on children that we haven’t already noted in adults.”

In the meantime, she said, parents with children need to continue to be cautious. That doesn’t mean families shouldn’t travel at all, but she recommends choosing to drive rather than fly; to not allow unvaccinated children to play unmasked with children from other households; and to remain vigilant about wearing masks and regularly washing hands while on the road.

View Source

As Mask Mandates Lift, Retail Workers Again Feel Vulnerable

Marilyn Reece, the lead bakery clerk at a Kroger in Batesville, Miss., started noticing more customers walking around the store without masks this month after the state mandate to wear face coverings was repealed. Kroger still requires them, but that doesn’t seem to matter.

When Ms. Reece, a 56-year-old breast-cancer survivor, sees those shoppers, she prays. “Please, please, don’t let me have to wait on them, because in my heart, I don’t want to ignore them, I don’t want to refuse them,” she said. “But then I’m thinking I don’t want to get sick and die, either. It’s not that people are bad, but you don’t know who they’ve come into contact with.”

Ms. Reece’s heightened anxiety is shared by retail and fast-food workers in states like Mississippi and Texas, where governments have removed mask mandates before a majority of people have been vaccinated and while troubling new variants of the coronavirus are appearing. It feels like a return to the early days of the pandemic, when businesses said customers must wear masks but there was no legal requirement and numerous shoppers simply refused. Many workers say that their stores do not enforce the requirement, and that if they do approach customers, they risk verbal or physical altercations.

“It’s given a great false sense of security, and it’s no different now than it was a year ago,” said Ms. Reece, who is not yet able to receive a vaccine because of allergies. “The only difference we have now is people are getting vaccinated but enough people haven’t gotten vaccinated that they should have lifted the mandate.”

translated into extra pay on top of their low wages. Grocery employees were not initially given priority for vaccinations in most states, even as health experts cautioned the public to limit time in grocery stores because of the risk posed by new coronavirus variants. (Texas opened availability to everyone 16 and older on Monday.)

The issue has gained serious prominence: On Monday, President Biden called on governors and mayors to maintain or reinstate orders to wear masks as the nation grapples with a potential rise in virus cases.

The United Food and Commercial Workers union, which represents nearly 900,000 grocery workers, said this month that at least 34,700 grocery workers around the country had been infected with or exposed to Covid-19 and that at least 155 workers had died from the virus. The recent mass shooting at a grocery store in Boulder, Colo., has only rattled workers further and added to concerns about their own safety.

Diane Cambre, a 50-year-old floor supervisor at a Kroger in Midlothian, Texas, said she had spent much of the past year worrying about bringing the virus home to her 9-year-old son and dreading interactions with customers who were flippant about the possibility of getting sick. She wears a double mask in the store even though it irritates her skin, already itchy from psoriasis, and changes her clothes as soon as she gets home.

end the statewide mask mandate the next week, Ms. Cambre said, customers immediately “started coming in not wearing a mask and stuff, and it’s been pretty hard getting anybody to wear one.” Management is supposed to offer masks to people who aren’t wearing them, but if they don’t put them on, nothing else is done, she said.

tantrums from cart-pushing adults.

“Some of our customers are drama-prone, so they’ll start yelling, ‘I’m not wearing that mask,’ and you can tell they’re very rude in their voice and very harsh,” Ms. Cambre, a U.F.C.W. member, said. Overseeing the self-checkout aisles has been especially challenging, she said, because customers who need help will demand that she come over, making it impossible to maintain six feet of distance.

At times when she has tried to explain the need for distancing, “they say, ‘OK, and that’s just a government thing,’” she said. “It really takes a toll on you mentally.”

A Kroger representative said that the chain would “continue to require everyone in our stores across the country to wear masks until all our frontline grocery associates can receive the Covid-19 vaccine,” and that it was offering $100 one-time payments to workers who received the vaccine.

The differing state and business mandates have some workers worried about more confrontations. The retail industry was already trying to address the issue last fall, when a major trade group helped put together training to help workers manage and de-escalate conflicts with customers who resisted masks, social distancing and store capacity limits. Refusing service to people without masks, or asking them to leave, has led to incidents in the past year like a cashier’s being punched in the face, a Target employee’s breaking his arm and the fatal shooting of a Family Dollar security guard.

This month in League City, Texas, near Houston, a 53-year-old man who refused to wear a required mask in a Jack in the Box confronted employees and then stabbed a store manager three times, according to a report in The Houston Chronicle. On March 14, a San Antonio ramen shop was vandalized with racist graffiti after its owner criticized Mr. Abbott on television for lifting the Texas mask mandate.

Office Depot in Texas City after she refused to wear a mask or leave the store, just days after an arrest warrant was issued for her in Galveston, Texas, for behaving similarly in a Bank of America location.

MaryAnn Kaylor, the owner of two antique stores in Dallas, including Lula B’s Design District, said the mask mandate repeal mattered a lot for stores and people’s behavior.

“He should have focused more on getting people vaccinated instead of trying to open everything up,” she said of Governor Abbott, noting that Texas has one of the country’s slowest vaccination rates.

“You still have cases every day in Texas, and you have people dying still from Covid,” she said. “This complete lifting of mandates is stupid. It shouldn’t have been based on politics — it should have been based on science.”

Some Texans have started to seek out mask-friendly establishments. Ms. Kaylor said that lists of Dallas businesses that require masks had been circulating on Facebook, and that people were consulting them to figure out where to buy groceries and do other shopping.

Emily Francois, a sales associate at a Walmart in Port Arthur, Texas, said that customers had been ignoring signs to wear masks and that Walmart had not been enforcing the policy. So Ms. Francois stands six feet away from shoppers who don’t wear masks, even though that upsets some of them. “My life is more important,” she said.

“I see customers coming in without a mask and they’re coughing, sneezing, they’re not covering their mouths,” said Ms. Francois, who has worked at Walmart for 14 years and is a member of United for Respect, an advocacy group. “Customers coming in the store without masks make us feel like we aren’t worthy, we aren’t safe.”

Phillip Keene, a spokesman for Walmart, said that “our policy of requiring associates and customers to wear masks in our stores has helped protect them during the pandemic, and we’re not lifting those measures at this time.”

Even before the pandemic, Ms. Reece, the Kroger clerk in Mississippi, was wearing a mask to protect herself from the flu because of her cancer diagnosis, she said.

She said 99 percent of customers in her small store had worn masks during the pandemic. “When they had to put it on, they did put it on,” she said. “It’s like giving a child a piece of candy — that child is going to eat that candy unless you take it from them.”

She is concerned about the potential harm from new variants, particularly from those who don’t cover their mouths. “You just have to pray and pray you don’t get within six feet of them, or 10 feet for that matter,” said Ms. Reece, who is also a U.F.C.W. member and has worked for Kroger for more than 30 years. “I know people want it to be back to normal, but you can’t just will it to be back to normal.”

View Source

Can U.S. Travelers Go To Europe? Here’s What to Know

With the number of people in the United States vaccinated against the coronavirus climbing, Americans are starting to explore their prospects for international travel this summer, a season when Europe is traditionally a big draw.

Most of Europe has been off-limits to most U.S. citizens for over a year, and the continent is currently grappling with a third wave of coronavirus infections and a surge in new, more contagious variants, making it unclear when its borders will reopen. But some European countries have started to welcome vaccinated travelers, including American tourists, and others are making preparations to ease restrictions in time for the summer season.

Vaccine and health certificates that would help speed travel are under development, which could make it easier for tourism to restart. The 27 member countries of the European Union have endorsed the idea of a vaccine certificate. While individual European countries will still set their own rules, the initiative is expected to establish a coordinated approach across the continent.

“Finally, we have a tangible solution to coordinating and harmonizing travel measures,” said Eduardo Santander, chief executive of the European Travel Commission, an association of national tourism organizations based in Brussels. “I think other countries like the U.S. will also come up with their own technological solutions that will be compatible and after a period of trials this summer, a global standard will be established.”

including Albania and Armenia.

As the number of cases has risen in Europe, and vaccination has been sluggish, several European Union countries have gone back into lockdown. France, Belgium and Portugal have reintroduced stringent measures that restrict nonessential travel, even from within the bloc and within what is known as the Schengen Zone, which includes nonmember countries that allow free movement across their borders.

“Right now, in some European countries, it might feel like you are in the middle of a storm, which is how we felt in the U.K a couple of months ago,” said Gloria Guevara Manzo, chief executive and president of the World Travel & Tourism Council, a forum that works with governments to raise awareness about the travel industry.

European Travel Agents’ and Tour Operators’ Association. “But right now, we are not talking about Americans visiting Europe.”

American travelers do have some options, though: Having brought the virus under control, Iceland is allowing all vaccinated travelers — including those from the United States — to enter without being subject to Covid-19 testing or quarantine measures.

Greece, one of the most popular European summer destinations for Americans, announced this month that it would reopen for all tourists in mid-May, as long as they show proof of vaccination, antibodies or a negative Covid-19 test result before traveling. All visitors will be subject to random testing upon arrival.

Turkey said it would not require international travelers to be vaccinated this summer and will re-evaluate testing policies after April 15.

Other European countries like Slovenia and Estonia are letting in vaccinated tourists, but not those from the United States.

several cruise lines have announced “staycation sailings” around the British Isles starting in June.

Many Britons traveled last summer when the virus seemed to have ebbed, and a recent study found that they brought a significant number of infections back into the United Kingdom. A ban on British travel abroad for leisure was enacted on Jan. 4 and was expected to expire in May, but the government introduced legislation this week that lays down the legal framework to extend the restrictions until the end of June.

It is not clear when exactly the United Kingdom lift its quarantine requirements for more tourism, but Visit Britain forecasts a slow recovery that will start toward late summer.

Earlier this month, the European Commission proposed a digital travel certificate that would prove that a person has been vaccinated, received a negative Covid-19 test result or recovered after contracting the virus.

States have different quarantine requirements, so travelers should check what their state requires before booking a vacation abroad.

Each country sets its own rules, but most safety protocols are unlikely to change this summer, even for those who have been vaccinated.

Visitors will be expected to wear masks and keep a safe distance in public spaces. Hotels, restaurants and event spaces will have enhanced cleaning protocols in place, and some may impose capacity restrictions.

Instagram, Twitter and Facebook. And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places list for 2021.

View Source

Businesses May Benefit From Sharing Covid Testing Resources, Study Suggests

“The surprising thing is just how robust that finding is in the face of some pretty plausible variations,” said A. David Paltiel, a professor of health policy and management at Yale School of Public Health, who was not involved in the study.

Still, he noted, there were plenty of scenarios that the model didn’t test, and the paper still needs to undergo a thorough peer review.

Its predictions should also be tested in the real world, Dr. O’Connor said: “It needs to be explored and tested head-to-head with other allocation methods.”

But if the findings hold up, it would suggest that schools and other institutions that are trying to reopen safely should think beyond their own walls when they develop testing programs. “Even if your goal is only to protect the students in your care, you will still be doing the maximum to protect those students by taking care of the people in the surrounding community,” Dr. Paltiel said. “That’s a pretty strong argument.”

Some universities are beginning to adopt this outlook. C.M.U. now offers free tests to all of its students’ self-reported contacts, whether or not they are affiliated with the university, and runs a testing site that is open to local residents, said Amy Bronson, a co-chair of the university’s Covid-19 task force and an author of the paper.

And in November, the University of California, Davis, began offering free coronavirus tests to anyone who lives or works in the city. The Healthy Davis Together program, a partnership with the city, has since administered more than 450,000 tests and identified more than 1,000 people with the virus, said Brad Pollock, an epidemiologist at U.C. Davis who directs the project.

“A virus does not respect geographic boundaries,” Dr. Pollock said. “It is ludicrous to think that you can get control of an acute infectious respiratory disease like Covid-19, in a city like Davis that hosts a very large university, without coordinated public health measures that connect both the university and the community.”

View Source

N.Y.C. Students To Be Able to Opt Into In-Person Learning in Public Schools, Mayor Says

New York City’s public school system, the nation’s largest, will give families another chance to enroll their children in in-person classes following new guidance released by the Centers for Disease Control and Prevention, Mayor Bill de Blasio said on Friday.

The new C.D.C. guidance allows elementary school students wearing masks to be spaced three feet apart, rather than six feet, in reopened schools. The city’s elementary schools, prekindergarten programs and programs for children with complex disabilities will adopt the new distancing guidelines in April, Mr. de Blasio said, allowing classrooms that have been operating at one-third capacity for many months to accommodate more students. With less distancing required between students, schools will be able to fit more children into each city classroom.

The city will continue to assess the risks of adjusting distancing rules for middle and high school students, Mr. de Blasio said. The C.D.C. said that its relaxed three-foot guideline only applies to to students in middle schools and high schools where community transmission is not high. (New York State has more recent cases per capita than any state except New Jersey, and the New York City metro area has the country’s second-highest rate of new cases behind only Idaho Falls, Idaho.)

The guidance still holds that adults in schools should keep six feet of distance from each other, and from students. New York City teachers have been eligible for the coronavirus vaccine since January.

many nonwhite families in particular are still wary of in-person learning, and it is likely that a significant number of parents will keep their children at home through the end of the school year in June.

New York’s schools, some of the first in the nation to reopen, have had extremely low positive test rates. Mr. de Blasio has committed to fully reopening the city’s school system this September for full-time instruction for any child who wants it. He has also said he expects the city to maintain a full-time remote option for some children this fall.

View Source

Europe’s Vaccine Ethics Call: Do No Harm and Let More Die?

European health agencies this week faced, with millions of lives in the balance, a staggeringly high-stakes incarnation of what ethicists call the trolley problem.

Imagine standing at a railway switch. If you do nothing, a trolley barreling down the track will hit three people in its path. If you pull the lever, the trolley will divert to an alternate track with one person. Which option is morally preferable: deliberately killing one person or passively allowing three to die?

In Europe’s version, German regulators identified seven cases of a rare cerebral blood clot, three of them fatal, out of 1.6 million who had received the AstraZeneca vaccine. Regulators had no proof they were linked, only a statistical anomaly. Still, continuing vaccinations might make them responsible for putting a handful of people in harm’s way — like pulling the lever on the trolley tracks.

Instead, the German authorities withdrew approval for the vaccine starting Monday. Neighboring countries followed, waiting for the European Union drug regulator to deem the vaccine safe, which it did on Thursday.

a third viral wave claiming thousands of lives per day in Europe, even a brief pause seemed all but certain to imperil many more lives than the unproven, very rare side effect.

Still, medical ethics can be tricky. Experts tend to view Europe’s decision as either an understandable, if risky, cost-benefit calculation or, as the Oxford University ethicist Jeff McMahan put it, “a disastrous mistake.”

Dr. McMahan, who studies life-or-death dilemmas, said that the extra Covid deaths likely to occur would “be by omission, or by not doing anything, rather than by causing. But you have to ask, does that make any difference in this context?”

But Ruth Faden, a Johns Hopkins University bioethicist and vaccine policy expert, called the pause “an extremely tough call.”

“If the only thing that mattered was deploying the vaccine in such a way as to reduce severe disease and death as quickly as possible, then you just go ahead,” Dr. Faden said. But it isn’t. While countries that continued vaccinations “probably made the right call,” she said, Germany and others faced real considerations around public trust and ethical duty.

principle calls for pausing any policy that might bring unforeseen harms in order to study those harms before proceeding. Imposing blind risk, however small, on unknowing citizens would be wrong.

But Dr. Persad said that he had “never really been able to make sense of how you would apply that principle in a pandemic.”

For one, even if vaccinations did carry some risk or uncertainty, the risk and uncertainty introduced by withholding them, therefore allowing cases to spread, was surely higher. It was not as if infections paused for bureaucratic process.

For another, vaccinations are voluntary.

“This is not a case where you’re imposing risk on unconsenting people,” Dr. Persad said, and therefore violating the precautionary principle. “You’re allowing people to consensually protect themselves from a big risk by taking a very small one.”

struck by lightning could be considered impermissible under that oath.

“But when the alternative to doing a small amount of harm is allowing a vast amount of harm, then the ‘do no harm’ slogan is a poor guide to policy,” said Dr. McMahan, the Oxford ethicist.

And while “first, do no harm” can feel like an iron law of medical ethics, it is in fact primarily a professional code of conduct. For centuries, it has reflected an inborn human bias that sees affirmatively causing harm as categorically different than passively allowing it.

already high in Europe, especially toward the AstraZeneca shot, on which Europe has built its plans. The proportion of people willing to get the shot has, in some polls, dropped significantly below the 70 percent needed to achieve herd immunity.

“High-profile, vivid events that are really scary have a way of controlling the public imagination,” Dr. Faden said.

Johnson & Johnson with a lower efficacy rate than two-shot variants, health officials hailed its simpler distribution as a breakthrough in the push for herd immunity. Americans have largely gone along.

“We don’t always see it,” Dr. Persad said of these ethical trade-offs, “but it actually comes up all the time.”

View Source

AstraZeneca Vaccine Is Safe, Europe’s Drug Regulator Says

The European Union’s drug regulator said on Thursday that the AstraZeneca vaccine was safe and effective, but that a warning label will be added to it, a finding that officials hope will alleviate concerns about possible side effects and prompt more than a dozen countries to resume using it against the resurgent coronavirus.

A review of millions of people who received vaccine found that it does not increase the risk of blood clots, though “there are still some uncertainties,” said Dr. Sabine Straus, who heads the European Medicines Agency’s risk assessment committee. A new warning will be added so that people in the medical community can be on the lookout for a potential rare complication leading to bleeding in the brain.

But the pause in using it, however brief, threatens lingering consequences both in Europe, which is struggling to contain a new wave of infection, and around the world.

Europe is not inoculating people quickly enough to slow transmission of the virus there, the World Health Organization said on Thursday, reporting that new infections had risen for three successive weeks and that more people in the region were dying from the disease than a year ago.

AstraZeneca vaccine shot, sold without the goal of earning a profit, is a keystone of the W. H.O.’s effort to inoculate poor and middle-income countries.

“This is a safe and effective vaccine,” said Emer Cooke, the head of the European regulator.

A fearful public may not be easily reassured.

“I haven’t decided yet whether I am going to get vaccinated or not,” said Giada Pietrolillo, a kindergarten teacher in Calabria, at the southern tip of Italy. “I am not sure I trust anyone any more.”

While the vast majority of the roughly 20 million people in Europe who have received the AstraZeneca shot suffered no serious side effects, Dr. Straus said, there were a handful of troubling cases of cerebral venous thrombosis, an abnormal clot formation, leading to brain bleeds, in patients who had low platelet counts. The evidence, she said, is not conclusive as to whether it is related to the vaccine

a move intended to reassure the public that all concerns were being treated seriously, adding that they would await guidance from the regulator. Most of the countries signaled that they were likely to restart using the vaccine once the agency issued clearance.

Despite their differences, all the vaccines approved by Western regulators have shown themselves to be remarkably effective at reducing severe illness and death. And though the AstraZeneca vaccine accounts for less than 20 percent of the hundreds of millions of doses ordered by the European Union, it was a critical part of early rollout plans.

With infections again on the rise in many European countries, the cost of delay may be measured in lives.

In just one week in January, at the height of the last wave, Europe recorded nearly 40,000 deaths.

This week, more people are on ventilators in hospitals in Poland than at any time in the pandemic, leading officials to reimpose national restrictions, starting on Saturday. Italy has reimposed lockdowns in the hopes of limiting outbreaks. Across the continent, there is rising concern about the spread of variants of the virus.

struggling to find enough beds in intensive care units.

President Emmanuel Macron of France said on Wednesday: “We are living through the hardest weeks now. We know it.”

sitting on some 30 million doses of the AstraZeneca vaccine, which has yet to be approved by the Food and Drug Administration.

Even Britain, which moved quickly to procure vaccines and has been rapidly administering doses to most people over the age of 50, has been forced to shift its strategy in part to deal with dips in supply.

Starting late last year, British regulators chose to allow an increased gap between the two doses of vaccine required for maximum protection: up to 12 weeks, rather than the three weeks used in clinical trials.

That has allowed Britain to give initial protection to about 25 million people. But many of those will soon need a second dose, putting pressure on the system and leading officials to warn that distribution in April will move slower.

restore faith in the AstraZeneca vaccine.

Concerns about it arose from reports of a small number of people who developed dangerous blood clots or abnormal bleeding after receiving the shot.

Different reports about potential side effects were conflated and a growing number of countries halted use of the shot.

The most concerning came from Norway and Germany, involving cases where blockage develops in veins that drain blood from the brain in patients who also had lowered platelets.

After several cases came to the attention of Paul Ehrlich Institute, the agency in charge of vaccine safety in Germany, the use of the vaccine was halted. A cascade of other European countries quickly followed suit. .

Klaus Cichutek, the head of the institute, said that it had acted after seven cases of cerebral venous thrombosis had occurred four to 16 days after vaccination.

An analysis by the institute suggested that only a single case would normally be expected among the 1.6 million people who received the vaccine in that time window.

The institute said that it had convened a group of experts on Monday and that they had agreed unanimously that a link to the vaccine was not implausible and should be investigated.

Ms. Cooke said that it was important to closely monitor all side effects.

“We are also launching additional investigations to understand more about these rare cases,” she said. But the regulatory agency found that it the benefits of the vaccine — at a moment when thousands are still dying around the world every day — outweighed the risk.

“If it was me,” Ms. Cooke said. “I would be vaccinated tomorrow.”

Reporting was contributed byNick Cumming-Bruce from Geneva and Gaia Pianigiani from Rome.

View Source